CLIMATE AND HEALTH COUNTRY PROFILE – 2015 EGYPT

OVERVIEW baseline of about one death per 100,000 annually between 1961 Egypt, a developing country with a population of 88 million,a has and 1990. A rapid reduction in emissions could limit heat-related achieved measurable success in improving population health deaths in the elderly to under 9 deaths per 100,000 in 2080. over the past few decades (World Bank, 2015). OPPORTUNITIES FOR ACTION Egypt, with the Mediterranean coastal region in the North and Egypt has conducted a financial needs assessment required to a very dry climate in other areas, is highly vulnerable to climate implement priority mitigation measures in the energy sector. change. Much of the population lives on the Nile Delta, and Egypt has also implemented actions to build institutional and any change in sea level rise threatens agricultural, water and technical capabilities to work on climate change and health. economic security. Furthermore, the country's double burden Country reported data (see section 6) indicate there are further of disease will be exacerbated by climate change. Increased opportunities for action in the following areas: temperatures could result in increased heat stress and higher rates of diseases such as skin cancers. Infectious and vector- 1) Adaptation borne diseases could also be exacerbated by changing weather • Conduct a national assessment of climate change impacts, and rainfall patterns. vulnerability and adaptation for health. • Include climate information in an Integrated Surveillance SUMMARY OF KEY FINDINGS and Response system with early warning and response • Under a high emissions scenario, mean annual temperature is systems for climate sensitive health risks. projected to rise by about 5.6°C on average from 1990 to 2100. • Strengthen adaptive capacity by building climate resilient If emissions decrease rapidly, the temperature rise is limited to infrastructure, including health infrastructure. about 1.6°C. • Conduct further cost estimations for the implementation of • Under a high emissions scenario, and without large heath resilience to climate change. investments in adaptation, an annual average of about 2) Mitigation 2.4 million people are projected to be affected by flooding due to sea level rise between 2070 and 2100. If emissions • Conduct valuation of co-benefits to health of climate decrease rapidly and there is a major scale up in protection (i.e. change mitigation policies. continued construction/raising of dikes) the annual affected • Use a multi-sectoral approach to mitigate and adapt to population could be limited to about 700 people. Adaptation sea-level rise with health-sector integration. alone will not offer sufficient protection, as sea level rise is a 3) National policy implementation long-term process, with high emissions scenarios bringing • Develop and approve a national health adaptation strategy. increasing impacts well beyond the end of the century. • Build on existing national climate change policies to ensure • Under a high emissions scenario heat-related deaths in the adequate human, financial and natural resources for such elderly (65+ years) are projected to increase to approximately adaptation and mitigation politices. 47 deaths per 100,000 by 2080 compared to the estimated

DEMOGRAPHIC ESTIMATES Population (2013)a 88 million Population growth rate (2013)a 2.2 % Population living in urban areas (2013)b 43.0 % Population under five (2013)a 12.7 % Population aged 65 or older (2013)a 5.1 % ECONOMIC AND DEVELOPMENT INDICATORS GDP per capita (current US$, 2013)c 3104 USD Total expenditure on health as % of GDP (2013)d 5.1 % Percentage share of income for lowest 20% of population (2008)c 9.3 % HDI (2013, +/- 0.01 change from 2005 is indicated with arrow)e 0.682  HEALTH ESTIMATES Life expectancy at birth (2013)f 71 years Under-5 mortality per 1000 live births (2013)g 26 a World Population Prospects: The 2015 Revision, UNDESA (2015) e United Nations Development Programme, Human Development Reports (2014) b World Urbanization Prospects: The 2014 Revision, UNDESA (2014) f Global Health Observatory, WHO (2014) c World Development Indicators, World Bank (2015) g Levels & Trends in Child Mortality Report 2015, UN Inter-agency Group on Child d Global Health Expenditure Database, WHO (2014) Mortality Estimation (2015) 1 CURRENT AND FUTURE CLIMATE HAZARDS

Due to climate change, many climate hazards and extreme weather events, such as heat waves, heavy rainfall and droughts, could become more frequent and more intense in many parts of the world. Outlined here are country–specific projections up to the year 2100 for climate hazards under a ‘business as usual’ high emissions scenario (in orange) compared to projections under a ‘two-degree’ scenario with rapidly decreasing emissions (in green).a Most hazards caused by climate change will persist for many centuries.

The text boxes below describe the projected changes averaged across about 20 models (thick line). The figures also show each model individually as well as the 90% model range (shaded) as a measure of uncertainty and, where available, the annual and smoothed observed record (in blue).b,c

MEAN ANNUAL TEMPERATURE DAYS OF WARM SPELL (‘HEAT WAVES’)

30 300 250 28 200 26 °C Days 150 24 30 100300 22 25050 28 2000 26 °C 1900 1950 2000 2050 2100 Days 150 1900 1950 2000 2050 2100 24 Year 100 Year 22 50 Under a high emissions scenario, mean annual temperature is Under a high emissions scenario, the number of days of warm projected to rise by about 5.6°C on average from 1990 to 2100. spelld is projected0 to increase from less than 10 days in 1990 to If emissions decrease rapidly, the temperature rise is limited to about 195 days on average in 2100. If emissions decrease rapidly, about 1.6°C. 1900 1950 2000 2050 2100 the days350 of 1900warm spell1950 are limited2000 to about2050 45 on2100 average. 15 Year 300 Year 250 DAYS WITH EXTREME RAINFALL (‘FLOOD RISK’) CONSECUTIVE DRY DAYS (‘DROUGHT’) 10 200 Days Days 150 350 155 100 300 50 250 0 0 10 200 Days Days 1900 1950 2000 2050 2100 150 1900 1950 2000 2050 2100 5 Year 100 Year 50 0 0

1900 1950 2000 2050 2100 1900 1950 2000 2050 2100 Year Year

Under a high emissions scenario, the number of days with very Under both high and low emissions scenarios, the longest dry heavy precipitation (20 mm or more) could increase by about spell is not indicated to change much from an average of about 2 days on average from 1990 to 2100, increasing the risk of 210 days, with continuing large year-to-year variability. floods. Some models indicate larger increases but year-to-year variability is very large. Due to this variability, projected changes in flood risk are not very different under a low emissions scenario.

a Model projections are from CMIP5 for RCP8.5 (high emissions) and RCP2.6 (low emissions). Model anomalies are added to the historical mean and smoothed. b Observed historical record of mean temperature is from CRU-TSv.3.22; observed historical records of extremes are from HadEX2. c Analysis by the Climatic Research Unit and Tyndall Centre for Climate Change Research, University of East Anglia, 2015. d A ‘warm spell’ day is a day when maximum temperature, together with that of at least the 6 consecutive previous days, exceeds the 90th percentile threshold for that time of the year. 2 CURRENT AND FUTURE HEALTH 2 RISKS DUE TO CLIMATE CHANGE

Human health is profoundly affected by weather and climate. Climate change threatens to exacerbate today’s health problems – deaths from extreme weather events, cardiovascular and respiratory diseases, infectious diseases and malnutrition – whilst undermining water and food supplies, infrastructure, health systems and social protection systems.

EXPOSURE TO FLOODING DUE TO SEA LEVEL RISE

Without With KEY IMPLICATIONS FOR HEALTH Adaptation Adaptation

RCP2.6 566,200 700 Egypt also faces inland river flood risk due to climate change. Under a high emissions scenario, it is projected that by 2030, 1.1 million additional 2,420,600 1,500 people may be at risk of river floods annually due to RCP8.5 Severity of climate climate of Severity change scenario climate change and 839,700 due to socio-economic * Medium ice melting scenario ** Values rounded to nearest ‘00 change above the estimated 986,100 annual affected population in 2010.a Under a high emissions scenario, and without large investments in adaptation, an annual average of about 2.4 million people are In addition to deaths from drowning, flooding causes projected to be affected by flooding due to sea level rise between extensive indirect health effects, including impacts on 2070 and 2100. If emissions decrease rapidly and there is a major food production, water provision, ecosystem disruption, scale up in protection (i.e. continued construction/raising of dikes) infectious disease outbreak and vector distribution. the annual affected population could be limited to about 700 Longer term effects of flooding may include post- people. Adaptation alone will not offer sufficient protection, as sea traumatic stress and population displacement. level rise is a long-term process, with high emissions scenarios bringing increasing impacts well beyond the end of the century.

Source: Human dynamics of climate change, technical report, Met Office, HM Government, UK, 2014.

INFECTIOUS AND VECTOR-BORNE DISEASES Estimated number of deaths due to diarrhoeal disease KEY IMPLICATIONS FOR HEALTH in children under 15 yrs in Egypt (base case scenario for economic growth) 1000 RCP 8.5 Some of the worlds most virulent infections are also With climate change highly sensitive to climate: temperature, precipitation 800 RCP 8.5 and humidity have a strong influence on the life-cycles No climate change of the vectors and the infectious agents they carry 600 RCP 2.6 and influence the transmission of water and food- With climate change borne diseases.b 400 RCP 2.6 No climate change Socioeconomic development and health interventions (children < 15 years) < 15 (children 200 are driving down burdens of several infectious

Estimated number of deaths deaths of number Estimated diseases, and these projections assume that this 0 will continue. However, climate conditions are 2030 2050 projected to become significantly more favourable for In the baseline year of 2008, there were an estimated 2,700 transmission, slowing progress in reducing burdens, diarrhoeal deaths in children under 15 years old. Under a high and increasing the populations at risk if control emissions scenario, diarrhoeal deaths attributable to climate measures are not maintained or strengthened.c change in children under 15 years old is projected to be about 10.9% of about 1,000 diarrheoal deaths projected in 2030. Although diarrheoal deaths are projected to decline to about 300 deaths by 2050, the proportion of deaths attributable to climate change could rise to approximately 15.2%.

Source: Lloyd, S., 2015.d

Mean relative vectorial capacity for dengue fever transmission Under both high and low emissions scenarios, the mean relative 0.40 vectorial capacity for dengue fever transmission is projected 0.35 0.30 to increase only slightly towards 2070. Co-factors such as 0.25 urbanization, development and population movements may 0.20 modify the disease burdens associated with dengue, and make 0.15 the disease cross new sub-national borders.

Mean relative relative Mean 0.10

vectorial capacity vectorial Source: Rocklöv, J., Quam, M. et al., 2015.d 0.05 0 Baseline RCP2.6 RCP8.5 RCP2.6 RCP8.5 1961–1990 2021–2050 2041–2070 a World Resources Institute, http://www.wri.org Assumes continued current socio-economic trends (SSP2) and a 10-year flood protection. b Atlas of Health and Climate , WHO & WMO 2012 c Quantitative risk assessment of the effects of climate change on selected causes of death, 2030s and 2050s. Geneva: World Health Organization, 2014. d Country-level analysis, completed in 2015, was based on health models outlined in the Quantitative risk assessment of the effects of climate change on selected causes of death, 2030s and 2050s. Geneva: World Health Organization, 2014. 3 HEAT-RELATED MORTALITY Heat-related mortality in population 65 years or over, Egypt KEY IMPLICATIONS FOR HEALTH (deaths / 100,000 population 65+ yrs) 50 Climate change is expected to increase mean annual 40 temperature and the intensity and frequency of heat 30 waves resulting in a greater number of people at risk of heat-related medical conditions. 20 65+ years The elderly, children, the chronically ill, the socially 10 isolated and at-risk occupational groups are particularly vulnerable to heat-related conditions. Deaths/100,000 population population Deaths/100,000 0 Baseline RCP2.6 RCP8.5 RCP2.6 RCP8.5 RCP2.6 RCP8.5 1961–1990 2030 2050 2080

Under a high emissions scenario heat-related deaths in the elderly (65+ years) are projected to increase to approximately 47 deaths per 100,000 by 2080 compared to the estimated baseline of about one death per 100,000 annually between 1961 and 1990. A rapid reduction in emissions could limit heat-related deaths in the elderly to under 9 deaths per 100,000 in 2080.

Source: Honda et al., 2015.a

HEAT STRESS AND LABOUR PRODUCTIVITY Annual daily work hours lost in relation to change in global mean temperature, Egypt (%)

10% 9% 8% Labour productivity is projected to 7% decline signifcantly under a high 6% emissions scenario. If global mean 5% temperature rises 4 degrees, about 4% 6% of annual daily work hours is 3% projected to be lost by workers 2% carrying out heavy labour (e.g. agricultural and industrial workers). 1% 0% Source: Kjellstrom, T. et al., 2015. http://www.climatechip.org/ 0 0.5 1 1.5 2 2.5 3 3.5 4 4.5 5 Increase in global mean temperature (C)

Heavy labour Moderate labour Light labour

UNDERNUTRITION

Climate change, through higher temperatures, land and water scarcity, flooding, drought and displacement, negatively impacts agricultural production and causes breakdown in food systems. These disproportionally affect those most vulnerable to hunger and can lead to food insecurity. Vulnerable groups risk further deterioration into food and nutrition crises if exposed to extreme weather events.b Without considerable efforts made to improve climate resilience, it has been estimated that the risk of hunger and malnutrition globally could increase by up to 20 percent by 2050.b In Egypt, the prevalence of child malnutrition in children under age 5 is 7.0% (2014).c

a Country-level analysis, completed in 2015, was based on health models outlined in the Quantitative risk assessment of the effects of climate change on selected causes of death, 2030s and 2050s. Geneva: World Health Organization, 2014. b World Food Project 2015 https://www.wfp.org/content/two-minutes-climate-change-and-hunger c World Health Organization, Global Database on Child Growth and Malnutrition [2015 edition]. Child malnutrition estimates are for % underweight, defined as: Percentage of children aged 0–59 months who are below minus two standard deviations from median weight-for-age of the World Health Organization (WHO) Child Growth Standards.

4 CURRENT EXPOSURES AND HEALTH 3 RISKS DUE TO AIR POLLUTION

Many of the drivers of climate change, such as inefficient and polluting forms of energy and transport systems, also contribute to air pollution. Air pollution is now one of the largest global health risks, causing approximately seven million deaths every year. There is an important opportunity to promote policies that both protect the climate at a global level, and also have large and immediate health benefits at a local level.

OUTDOOR AIR POLLUTION EXPOSURE Outdoor air pollution in cities in Egypt KEY IMPLICATIONS FOR HEALTH annual mean PM2.5 (μg/m3) 2011*

WHO annual mean PM guideline value (10 μg/m3) 2.5 Outdoor air pollution can have direct and sometimes 80 severe consequences for health.

70 Fine particles which penetrate deep into the 3 respiratory tract subsequently increase mortality 60 g/m from respiratory infections, lung cancer, and

, μ cardiovascular disease.

2.5 50

40

30

20 Annual mean PM 10

0 Cairo Delta cities

In 2011, Cairo and Delta cities, for which there was air quality data available, had annual mean PM2.5 levels that were above the WHO guideline value of 10 µg/m3.

Source: Ambient Air Pollution Database, WHO, May 2014. * A standard conversion has been used, please see source for further details.

OUTDOOR AIR POLLUTION AND SHORT LIVED CLIMATE POLLUTANTS

KEY IMPLICATIONS FOR HEALTH

Short-lived climate pollutants such as black carbon, methane and tropospheric ozone – released through inefficient use and burning of biomass and fossil fuels for transport, housing, power production, waste disposal (municipal and agricultural), industry and forest fires – are responsible for a substantial fraction of global warming as well as air-pollution related deaths and diseases.

Since short-lived climate pollutants persist in the atmosphere for weeks or months while CO2 emissions persist for years, significant reductions of SLCP emissions could reap immediate health benefits and health cost savings, and generate very rapid climate benefits – helping to reduce near-term climate change by as much as 0.5oC before 2050.a

In Egypt, it is estimated that a reduction in SLCPs* could prevent about 13,200 premature deaths attributed to outdoor air pollution per year, from 2030 onwards (Shindell, D., Science, 2012).

* Through implementation of 14 reduction measures: 7 targeting methane emissions and the rest, emissions from incomplete combustion. See source for further detail.

5 4 CO-BENEFITS TO HEALTH FROM CLIMATE CHANGE MITIGATION

Health co-benefits are local, national and international measures with the potential to simultaneously yield large, immediate public health benefits and reduce the upward trajectory of greenhouse gas emissions. Lower carbon strategies can also be cost-effective investments for individuals and societies. Presented here are examples of opportunities for health co-benefits that could be realised by action in important greenhouse gas emitting sectors.a

Transport Electricity Transport injuries lead to Generation 1.2 million deaths every year, Current patterns of electricity and land use and transport planning generation in many parts of the contribute to the 2–3 million deaths from world, particularly the reliance on coal physical inactivity. The transport sector is combustion in highly polluting power plants, also responsible for some 14% (7.0 GtCO2e) contribute heavily to poor local air quality, of global carbon emissions. The IPCC has noted causing cancer, cardiovascular and respiratory significant opportunities to reduce energy demand in disease. Outdoor air pollution is responsible for the sector, potentially resulting in a 15%–40% reduction 3.7 million premature deaths annually. High-income in CO2 emissions, and bringing substantial opportunities countries still have work to do in transitioning to cleaner for health: A modal shift towards walking and cycling could and healthier energy sources. see reductions in illnesses related to physical inactivity and reduced outdoor air pollution and noise exposure; The health benefits of transitioning from fuels such as coal increased use of public transport is likely to result in reduced to lower carbon sources, including ultimately to renewable GHG emissions; compact urban planning fosters walkable energy, are clear: Reduced rates of cardiovascular and residential neighborhoods, improves accessibility respiratory disease such as stroke, lung cancer, coronary to jobs, schools and services and can encourage artery disease, and COPD; cost-savings for health physical activity and improve health equity by systems; improved economic productivity from a making urban services more accessible to the healthier and more productive workforce. elderly and poor.

Food and Agriculture Healthcare Systems Agricultural emissions account for some Health care activities are an important source 5.0–5.8 GtCO2eq annually, with food of greenhouse gas emissions. In the US and in and nutrition constituting an important EU countries, for example, health care activities determinant of health. Many high-income account for between 3–8% of greenhouse countries are feeling the burden of poor diet gas (CO2-eq) emissions. Major sources include and obesity-related diseases, with some 1.9 billion procurement and inefficient energy consumption. adults overweight globally. Modern, on-site, low-carbon energy solutions (e.g. solar, wind, or hybrid solutions) and the development A wide range of interventions designed to reduce emissions of combined heat and power generation capacity in larger from agriculture and land-use will also yield positive benefits facilities offer significant potential to lower the health sector’s for public health. For example, policy and behavioural carbon footprint, particularly when coupled with building interventions to encourage a reduction in red meat and equipment energy efficiency measures. Where consumption and a shift towards local and seasonal electricity access is limited and heavily reliant upon fruit and vegetables, which tend to have lower diesel generators, or in the case of emergencies when carbon emissions associated with their production, local energy grids are damaged or not operational, will improve diets and result in reductions in such solutions can also improve the quality and cardiovascular disease and colorectal cancer. reliability of energy services. In this way, low carbon energy for health care could not only mitigate climate change, it could enhance access to essential health services and ensure resilience.

Text

a For a complete list of references used in the health co-benefits text please see the Climate and Health Country Profile Reference Document, http://www.who.int/globalchange/en/

6 EMISSIONS AND 5 COMMITMENTS

Global carbon emissions increased by 80% from 1970 to 2010, and continue to rise.a,b Collective action is necessary, but the need and opportunity to reduce greenhouse gas emissions varies between countries. Information on the contribution of different sectors, such as energy, manufacturing, transport and agriculture, can help decision-makers to identify the largest opportunities to work across sectors to protect health, and address climate change.

Egypt ANNUAL GREENHOUSE GAS EMISSIONS A 2ºC upper limit of temperature increase relative to pre-industrial levels has been (metric tonnes CO2 equivalent) internationally agreed in order to prevent

250,000,000 severe and potentially catastrophic impacts 1990 2000 from climate change. Reductions are necessary across countries and sectors. In order to stay 200,000,000 below the 2ºC upper limit it is estimated that global annual CO2-energy emissions, currently equivalent

2 150,000,000 at 5.2 tons per capita, need to be reduced to 1.6 tons per capita.c 100,000,000

50,000,000 Metric tonnes CO 0 Energy Manufac- Transport Agriculture Waste Other Total excl Industries turing and ­LULUCF/LUCF ­Construction

The most recent emissions data for Egypt is from the year 2000. At that time, carbon emissions were increasing across most sectors. Through intersectoral collaboration, the health community can help to identify the best policy options not only to eventually stabilize greenhouse gas emissions, but also to provide the largest direct benefits to health.

Source: UNFCCC Greenhouse Gas Data Inventory, UNFCCC (2015).

NATIONAL RESPONSEd

1992 EGYPT SIGNED THE UNFCCC 1999 EGYPT SIGNED THE KYOTO PROTOCOL

NATIONAL ENVIRONMENTAL, ECONOMIC AND 2010 DEVELOPMENT STUDY (NEEDS) FOR CLIMATE CHANGE

NATIONAL STRATEGY FOR ADAPTATION TO CLIMATE 2011 CHANGE AND DISASTER RISK REDUCTION a Boden, T.A., G. Marland, and R.J. Andres (2010). Global, Regional, and National Fossil-Fuel CO2 Emissions. Carbon Dioxide Information Analysis Center, Oak Ridge National Laboratory, U.S. Department of Energy, Oak Ridge, Tenn., U.S.A. doi 10.3334/CDIAC/00001_V2010. b IPCC (2014) Blanco G., R. Gerlagh, S. Suh, J. Barrett, H.C. de Coninck, C.F. Diaz Morejon, R. Mathur, N. Nakicenovic, A. Ofosu Ahenkora, J. Pan, H. Pathak, J. Rice, R. Richels, S.J. Smith, D.I. Stern, F.L. Toth, and P. Zhou, 2014: Drivers, Trends and Mitigation. In: Climate Change 2014: Mitigation of Climate Change. Contribution of Working Group III to the Fifth Assessment Report of the Intergovernmental Panel on Climate Change [Edenhofer, O., R. Pichs-Madruga, Y. Sokona, E. Farahani, S. Kadner, K. Seyboth, A. Adler, I. Baum, S. Brunner, P. Eickemeier, B. Kriemann, J. Savolainen, S. Schlömer, C. von Stechow, T. Zwickel and J.C. Minx (eds.)]. Cambridge University Press, Cambridge, United Kingdom c Pathways to deep decarbonization, Sustainable development Solutions Network, 2014 report. d Columbia Law School, 'Climate Change Laws Of The World'. N.p., 2015.

7 6 NATIONAL POLICY RESPONSE

The following table outlines the status of development or implementation of climate resilient measures, plans or strategies for health adaptation and mitigation of climate change (reported by countries).a

GOVERNANCE AND POLICY

Country has identified a national focal point for climate change in the Ministry of Health

Country has a national health adaptation strategy approved by relevant government body

The National Communication submitted to UNFCCC includes health implications of climate change mitigation policies

HEALTH ADAPTATION IMPLEMENTATION

Country is currently implementing projects or programmes on health adaptation to climate change

Country has implemented actions to build institutional and technical capacities to work on climate change and health

Country has conducted a national assessment of climate change impacts, vulnerability and adaptation for health

Country has climate information included in Integrated Disease Surveillance and Response (IDSR) system, including development of early warning and response systems for climate-sensitive health risks

Country has implemented activities to increase climate resilience of health infrastructure

FINANCING AND COSTING MECHANISMS

Estimated costs to implement health resilience to climate change included in planned allocations from domestic funds in the last financial biennium

Estimated costs to implement health resilience to climate change included in planned allocations from international funds in the last financial biennium

HEALTH BENEFITS FROM CLIMATE CHANGE MITIGATION

The national strategy for climate change mitigation includes consideration of the health implications (health risks or co-benefits) of climate change mitigation actions

Country has conducted valuation of co-benefits of health implications of climate mitigation policies

a Supporting monitoring efforts on health adaptation and mitigation of climate change: a systematic approach for tracking progress at the global level. WHO survey, 2015.

For further information please contact: World Health Organization 20 Avenue Appia 1211 Geneva 27 Switzerland Tel.: +41 22 791 3281 | Fax: +41 22 791 4853 http://www.who.int/globalchange/en/

All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. The estimates and projections provided in this document have been derived using standard categories and methods to enhance their cross-national comparability. As a result, they should not be regarded as the nationally endorsed statistics of Member States which may have been derived using alternative methodologies.

To ensure readability, health estimates and projections have been presented without the margins of uncertainty which are available upon request. WHO/FWC/PHE/EPE/15.01